Journal article
Predicting Risk of Postoperative Lung Injury in High-risk Surgical Patients: A Multicenter Cohort Study
Anesthesiology (Philadelphia), Vol.120(5), pp.1168-1181
05/2014
DOI: 10.1097/ALN.0000000000000216
PMCID: PMC3999474
PMID: 24755786
Abstract
BACKGROUND:Acute respiratory distress syndrome (ARDS) remains a serious postoperative complication. Although ARDS prevention is a priority, the inability to identify patients at risk for ARDS remains a barrier to progress. The authors tested and refined the previously reported surgical lung injury prediction (SLIP) model in a multicenter cohort of at-risk surgical patients.
METHODS:This is a secondary analysis of a multicenter, prospective cohort investigation evaluating high-risk patients undergoing surgery. Preoperative ARDS risk factors and risk modifiers were evaluated for inclusion in a parsimonious risk-prediction model. Multiple imputation and domain analysis were used to facilitate development of a refined model, designated SLIP-2. Area under the receiver operating characteristic curve and the Hosmer–Lemeshow goodness-of-fit test were used to assess model performance.
RESULTS:Among 1,562 at-risk patients, ARDS developed in 117 (7.5%). Nine independent predictors of ARDS were identifiedsepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20 to 29 and ≥30 breaths/min), FIO2 greater than 35%, and SpO2 less than 95%. The original SLIP score performed poorly in this heterogeneous cohort with baseline risk factors for ARDS (area under the receiver operating characteristic curve [95% CI], 0.56 [0.50 to 0.62]). In contrast, SLIP-2 score performed well (area under the receiver operating characteristic curve [95% CI], 0.84 [0.81 to 0.88]). Internal validation indicated similar discrimination, with an area under the receiver operating characteristic curve of 0.84.
CONCLUSIONS:In this multicenter cohort of patients at risk for ARDS, the SLIP-2 score outperformed the original SLIP score. If validated in an independent sample, this tool may help identify surgical patients at high risk for ARDS.
Details
- Title: Subtitle
- Predicting Risk of Postoperative Lung Injury in High-risk Surgical Patients: A Multicenter Cohort Study
- Creators
- Daryl Kor - From the Department of Anesthesiology (D.J.K.), Department of Health Sciences Research (R.K.L., R.E.C.), and Department of Medicine, Division of Pulmonary and Critical Care Medicine (O.G.), Mayo Clinic, Rochester, Minnesota; Department of Surgery (P.K.P.) and Department of Anesthesiology (J.M.B.), University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Surgery (H.L.A.), St Joseph Mercy Hospital, Ann Arbor, Michigan; Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts (P.C.H.); Department of Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina (J.J.H.); Departme nt of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.K.B.); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (R.R.B.); Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas (A.A.); Department of Critical Care, Mayo Clinic, Jacksonville, Florida (E.F.); Department of Medicine, Albert Einstein College of Medicine, Bronx, New York (M.N.G.); and Department of Anaesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (D.S.T.)Ravi LingineniOgnjen GajicPauline ParkJames Blum - University of Iowa, AnesthesiaPeter HouJ HothHarry AndersonEdnan BajwaRaquel BartzAdebola AdesanyaEmir FesticMichelle GongRickey CarterDaniel Talmor
- Resource Type
- Journal article
- Publication Details
- Anesthesiology (Philadelphia), Vol.120(5), pp.1168-1181
- Publisher
- American Society of Anesthesiologists, Inc
- DOI
- 10.1097/ALN.0000000000000216
- PMID
- 24755786
- PMCID
- PMC3999474
- ISSN
- 0003-3022
- eISSN
- 1528-1175
- Language
- English
- Date published
- 05/2014
- Academic Unit
- Anesthesia
- Record Identifier
- 9984013165002771
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